Written By: Aileen Moradian, PhD, MSN-Ed., RNC-NIC, IBCLC, FMP-BC
How Hyperbaric Therapy Supports Patients with Diabetes
Diabetes remains one of the most pressing public health challenges worldwide, affecting millions of individuals and increasing the risk for serious complications. Among the most difficult complications are chronic wounds, especially diabetic ulcers, which often resist standard treatments. When wounds fail to close, the risks of infection, hospitalization, and amputation rise dramatically. For this reason, clinicians and researchers have increasingly explored hyperbaric oxygen therapy (HBOT) as part of an integrative approach in hyperbaric medicine.
HBOT involves breathing nearly 100% oxygen in a pressurized chamber, which raises oxygen levels in blood plasma far beyond what the body normally achieves. This surge in oxygen availability can positively influence multiple physiological pathways crucial for wound healing.
The Science Behind HBOT and Diabetes
Diabetes alters vascular health, weakens immune function, and disrupts collagen production. Each of these effects makes tissue repair more challenging. HBOT offers a unique solution by increasing the diffusion of oxygen into hypoxic tissue, which helps to:
- Enhance leukocyte activity for better infection control
- Stimulate angiogenesis, or new blood vessel formation
- Support fibroblast function and collagen synthesis
- Improve antimicrobial effects by disrupting biofilm activity
These benefits are particularly relevant for diabetic wounds, which frequently stall due to poor circulation and compromised immunity.
Diabetic Ulcers and Non-Healing Wounds
Diabetic ulcers in people with diabetes remain a leading cause of morbidity. Even with aggressive management—such as debridement, antibiotic therapy, vascular assessment, and strict off-loading—some ulcers persist. When this happens, HBOT may serve as an adjunctive therapy.
A growing body of research highlights how HBOT can accelerate closure rates and reduce amputation risk. A 2024 systematic review found that patients receiving HBOT alongside standard wound care showed significantly higher rates of complete ulcer healing compared to standard care alone (Tao et al., 2024). These results support HBOT’s role as a valuable tool in wound healing, though it is not intended to replace conventional management.
Evidence from Hyperbaric Medicine
Multiple clinical reviews have examined HBOT for diabetic wounds. Imam et al. (2023) observed that HBOT often improved healing outcomes, particularly in patients with advanced ulcers. Similarly, guidelines from the International Working Group on the Diabetic (Chen et al., 2024) recommend HBOT in select cases, especially when standard therapies have failed.
While promising, the evidence is not universally strong. Some trials show neutral results, often due to variations in patient selection, wound severity, and treatment adherence. Nonetheless, the consensus is that HBOT should be considered for patients with severe, non-healing ulcers who are at high risk of limb loss.
Beyond Wounds: HBOT and Chronic Pain
Although HBOT is most established in treating chronic diabetic wounds, researchers are also exploring its role in managing chronic pain. Oxygen under pressure may reduce inflammatory mediators and support neural repair, making it a potential adjunct for painful conditions that often coexist with diabetes, such as peripheral neuropathy.
Protocols and Safety
Typical HBOT protocols for diabetes-related wounds involve sessions at 2.0 to 2.5 ATA pressure, lasting 90 minutes, three to five days per week, for several weeks. Throughout treatment, patients continue to receive meticulous wound care and glucose management.
The therapy is generally safe but can cause temporary side effects, such as ear barotrauma, sinus pressure, or mild vision changes. Rarely, oxygen toxicity seizures can occur, though these events are uncommon with modern safety standards (Vahabi et al., 2023).
Patient Selection and Expectations
Hyperbaric oxygen therapy (HBOT) is especially valuable for individuals with advanced diabetic ulcers poor circulation, or wounds that have not responded to weeks of standard care. These are the cases where time is critical, and the risk of serious complications is highest.
By delivering oxygen under pressure, HBOT provides the body with what it needs most: enhanced oxygenation that supports new blood vessel growth, stimulates collagen production, strengthens the immune system, and accelerates tissue repair. This powerful combination helps stubborn wounds move from “stalled” to “healing.”
When integrated with vascular care, infection management, off-loading, and glucose control, HBOT can significantly improve healing outcomes, reduce the risk of amputation, and restore confidence for patients struggling with slow recovery. It’s a therapy designed to give hope, progress, and a chance at a better quality of life.
Conclusion
For patients with diabetes facing the challenge of chronic wounds, hyperbaric oxygen therapy offers a scientifically supported option to complement traditional care. By enhancing tissue oxygenation, HBOT addresses one of the core barriers to healing and may reduce the devastating risk of amputation. Although further large-scale studies are needed, the current body of evidence places HBOT as a valuable tool within the broader practice of hyperbaric medicine.
Summary Points
- Diabetes impairs circulation and immunity, often leading to non-healing wounds.
- Hyperbaric oxygen therapy (HBOT) improves tissue oxygenation and supports multiple steps in wound repair.
- Evidence shows HBOT can increase healing rates and lower amputation risk in diabetic ulcers.
- HBOT is used as an adjunct to best-practice wound care, not a stand-alone treatment.
- Potential benefits extend to chronic pain, though research is still emerging.
- Best candidates are patients with severe, persistent ulcers unresponsive to standard therapy.
References
- Guidelines on interventions to enhance healing of foot ulcers in persons with diabetes
- Safe use of hyperbaric oxygen therapy in the treatment of diabetic foot wounds
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